| NPI | 1811791239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209.032257) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041416978) |
| Enumeration Date | 2025-04-03 |
| Last Update Date | 2025-04-22 |