| NPI | 1568275337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084A2900X Psychiatry & Neurology, Neurocritical Care (Licence: IL 209.032404) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.538332) |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-07-29 |