| NPI | 1134942444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.0312700) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: IL 041457942) |
| Enumeration Date | 2024-11-05 |
| Last Update Date | 2025-05-12 |