| NPI | 1528584208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209016257) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.016257) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209016257) | |
| Enumeration Date | 2017-08-15 |
| Last Update Date | 2023-11-27 |