NPI | 1831593557 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209011724) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: IL 209.011724) |
Enumeration Date | 2014-10-09 |
Last Update Date | 2015-04-11 |