| NPI | 1558241315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209.036034) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.604612) |
| 163WE0003X Registered Nurse, Emergency (Licence: IN 28282759A) | |
| Enumeration Date | 2025-09-03 |
| Last Update Date | 2026-07-24 |