| NPI | 1295268381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: IL 277.005604) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 277.005604) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2026-05-06 |