| NPI | 1952887093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: IL 209022856) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: IL 209022856) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: MD R223957) | |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2021-04-15 |