| NPI | 1780446427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.031293) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WI 260346-30) |
| 163WE0003X Registered Nurse, Emergency (Licence: IL 041.512395) | |
| 363L00000X Nurse Practitioner (Licence: WI 15988-33) | |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2025-01-27 |