| NPI | 1043192297 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209032423) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209032423) |
| Enumeration Date | 2025-07-21 |
| Last Update Date | 2025-07-29 |