| NPI | 1548544158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 041361945) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001155943) |
| 163WE0003X Registered Nurse, Emergency (Licence: IL 041361945) | |
| Enumeration Date | 2011-09-30 |
| Last Update Date | 2023-10-02 |