| NPI | 1285148882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209022731) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH RN.373538) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: OH 022331) | |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2022-08-25 |