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In 2367, he treated Commander William T. Riker, who was disguised as a Malcorian, after he was injured during a surveillance mission. When he discovered physical differences between Riker and Malcorian physical aspects, he informed Minister of Security Krola. Nilrem was ordered by the minister to wake Riker, although this was a medical risk. He did so and was promoted to acting director of the Sikla Medical Facility. (TNG: "First Contact")