| NPI | 1841919495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209025759) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: IL 041359029) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: IL 209025759) | |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2023-01-30 |