NPI | 1700391448 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 277.000547) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209016524) |
Enumeration Date | 2017-12-04 |
Last Update Date | 2021-12-18 |