| NPI | 1518300813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP014911) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP013399) |
| 364SF0001X Clinical Nurse Specialist, Family Health (Licence: PA SP014911) | |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2019-05-22 |