| NPI | 1407474018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277.002722) |
| Additional Taxonomies | 367A00000X Advanced Practice Midwife (Licence: IL 277002722) |
| Enumeration Date | 2020-07-09 |
| Last Update Date | 2025-07-23 |