| NPI | 1841236254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 041298117) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 041298117) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 041298117) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 041298117) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2007-07-08 |