| NPI | 1194514109 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209032303) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.032303) |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2026-03-12 |