| NPI | 1932566288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95015046) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CA 95015046) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209013781) | |
| Enumeration Date | 2016-01-18 |
| Last Update Date | 2020-08-22 |