| NPI | 1518201219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209009967) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic |
| 163WA2000X Registered Nurse, Administrator (Licence: IL 041314111) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: IL 041314111) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209010017) | |
| 364SC0200X Clinical Nurse Specialist, Critical Care Medicine (Licence: IL 209010017) | |
| 364SE0003X Clinical Nurse Specialist, Emergency (Licence: IL 209010017) | |
| Enumeration Date | 2012-11-19 |
| Last Update Date | 2022-02-03 |