| NPI | 1487194205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209021494) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MI 4704251455) |
| Enumeration Date | 2017-02-27 |
| Last Update Date | 2023-11-27 |