| NPI | 1538754395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 10771-33) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209.022918) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 10771-33) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.022918) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WI 10771-33) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209.022918) | |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2026-04-20 |