| NPI | 1093908774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP010340) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 200700421322) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP010341) | |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2021-07-07 |