| NPI | 1760335566 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209034440) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209.034440) |
| Enumeration Date | 2026-02-19 |
| Last Update Date | 2026-03-17 |