| NPI | 1417168022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209-005563) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209005563) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2025-05-01 |