| NPI | 1619868650 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209033481) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 041456978) |
| Enumeration Date | 2025-07-09 |
| Last Update Date | 2026-01-21 |