| NPI | 1689447500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209028094) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28240550A) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IN 71014667A) | |
| Enumeration Date | 2023-11-02 |
| Last Update Date | 2025-08-15 |