| NPI | 1558890517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP025641) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 431271) |
| Enumeration Date | 2017-06-05 |
| Last Update Date | 2022-08-11 |