| NPI | 1942451000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.024822) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041-341955) |
| Enumeration Date | 2008-10-08 |
| Last Update Date | 2022-04-11 |