| 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 |