| NPI | 1255870796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 206.015167) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209015167) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209015167) | |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2026-08-03 |