| NPI | 1750162780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209.028387) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209.028387) |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2023-10-05 |