| NPI | 1063091825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209023127) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IL 041436954) |
| Enumeration Date | 2021-04-07 |
| Last Update Date | 2026-02-27 |