| NPI | 1952038465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 041599340) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2025014034) |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2026-01-05 |