| NPI | 1609384908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LG0600X Nurse Practitioner Gerontology (Licence: PA SP026878) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN623561) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: PA SP026878) | |
| 363LF0000X Nurse Practitioner Family (Licence: PA SP018364) | |
| 363LF0000X Nurse Practitioner Family (Licence: NY F342461-1) | |
| Enumeration Date | 2018-01-21 |
| Last Update Date | 2023-11-09 |