| NPI | 1962963116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209022982) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 200971) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MA RN2319796) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2023-02-13 |