| NPI | 1316100191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA UP006375H) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA UP006375H) |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2020-10-13 |