| NPI | 1760073530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209022087) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: IL 209.022087) |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2022-09-28 |