| NPI | 1558731562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP015540) |
| Additional Taxonomies | 163WH1000X Registered Nurse, Hospice (Licence: PA RN535735) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP015540) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP015540) | |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2016-04-20 |