| NPI | 1922406313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.012426) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: IL 041-337092) |
| 363L00000X Nurse Practitioner (Licence: TX 1015374) | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2024-02-01 |