| NPI | 1649774126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209027847) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 24113) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2023-09-15 |