| NPI | 1053022202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209026502) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.026502) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.026502) | |
| Enumeration Date | 2022-12-08 |
| Last Update Date | 2024-07-12 |