NPI | 1790272789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209017475) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.017475) |
Enumeration Date | 2018-04-16 |
Last Update Date | 2021-06-30 |