| NPI | 1740223775 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041-297687) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209-004955) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2007-07-08 |