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 |