| NPI | 1659855872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.018230) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209-018230) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209-018230) | |
| 208M00000X Hospitalist (Licence: IL 209-018230) | |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2024-06-04 |