| NPI | 1730683228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IA A179234) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IL 041.400942) |
| 363L00000X Nurse Practitioner (Licence: IL 209.017524) | |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2024-08-14 |