| 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 |