| NPI | 1194146118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP030692) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP013529) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP013529) | |
| 363L00000X Nurse Practitioner (Licence: PA SP013529) | |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2026-08-24 |