| NPI | 1538872056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 1152911) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041465817) |
| 363L00000X Nurse Practitioner (Licence: IL 209026668) | |
| Enumeration Date | 2022-12-29 |
| Last Update Date | 2024-08-09 |