| NPI | 1144025750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: IL 209-031037) |
| Additional Taxonomies | 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: IL 209-031037) |
| Enumeration Date | 2025-02-17 |
| Last Update Date | 2025-07-29 |