| NPI | 1033866124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP024641) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP024641) |
| Enumeration Date | 2022-03-08 |
| Last Update Date | 2024-03-14 |