| NPI | 1336501824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209.013903) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209013903) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 289233) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CO RXN.0106317-NP) | |
| Enumeration Date | 2016-03-23 |
| Last Update Date | 2024-05-01 |