| NPI | 1831867555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209031123) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MI 4704351690) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71014328A) | |
| Enumeration Date | 2021-08-30 |
| Last Update Date | 2026-02-05 |