| NPI | 1801639596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209029825) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209.029825) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2024-08-28 |