| NPI | 1619394285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024174160) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209011321) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0024174160) | |
| Enumeration Date | 2014-03-21 |
| Last Update Date | 2023-09-07 |