| NPI | 1629310503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209-009044) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209-009044) |
| Enumeration Date | 2013-03-19 |
| Last Update Date | 2025-04-07 |