| NPI | 1891310538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95014440) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209021013) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209.021013) | |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2020-10-13 |