| NPI | 1518588367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209029057) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 011624) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11006843) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: CT 011624) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN11006843) | |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2025-08-13 |