| NPI | 1902503055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209-027231) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041374043) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 209027231) | |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2024-11-04 |