| NPI | 1568317931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209035263) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 041451790) |
| Enumeration Date | 2026-03-02 |
| Last Update Date | 2026-07-14 |