| NPI | 1952175994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209028256) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: IL 209-028256) |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2024-11-05 |