| NPI | 1619513702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP021184) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP021184) |
| Enumeration Date | 2019-11-23 |
| Last Update Date | 2023-03-28 |