| NPI | 1306319504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN11012083) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN665586) |
| 163W00000X Registered Nurse (Licence: DE L1-0051159) | |
| 163W00000X Registered Nurse (Licence: NJ 26NR19510400) | |
| 363L00000X Nurse Practitioner (Licence: PA SP019728) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP019728) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP019728) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP019728) | |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2022-03-01 |