| NPI | 1497993380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9286928) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 277001209) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL APRN9286928) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9286928) | |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2023-09-12 |