| NPI | 1386596211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.034888) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209034888) |
| Enumeration Date | 2026-02-12 |
| Last Update Date | 2026-03-27 |