| NPI | 1841579026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209008969) |
| Additional Taxonomies | 2086S0129X Surgery, Vascular Surgery (Licence: IL 209.008969) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2021-12-23 |