| NPI | 1538772033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209028615) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 10741) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2023-11-21 |