| NPI | 1891561445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.029396) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 14636-33) |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2024-10-02 |