NPI | 1922660042 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: MO 2019023256) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 277003193) |
363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: MO 2024011384) | |
Enumeration Date | 2019-06-28 |
Last Update Date | 2024-07-03 |