| NPI | 1417322447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: DE LP0000202) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LP0000202) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00622900) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: DE L8-0010551) | |
| 163W00000X Registered Nurse (Licence: PA RN655557) | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2025-04-30 |