| NPI | 1477969764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IL 277-001333) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209011581) |
| Enumeration Date | 2014-07-07 |
| Last Update Date | 2025-02-25 |