| NPI | 1295053445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP010406) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP10405) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2018-06-11 |