| NPI | 1366957102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP018246) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NJ 26NJ14933500) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2024-07-06 |