| NPI | 1497504195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP029745) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP029745) |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2024-06-18 |