| NPI | 1346441367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277004797) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 277004797) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2026-05-07 |