| NPI | 1487254744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA 2019010539) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA 2019010539) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: PA 2019010539) | |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-10-27 |