| NPI | 1346832334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 209027767) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209027767) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-12-27 |