| NPI | 1730819954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA 703160) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0074494) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: DE LP-0010813) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: DE LP-0010813) | |
| 363L00000X Nurse Practitioner (Licence: DE LP-0010813) | |
| Enumeration Date | 2022-06-11 |
| Last Update Date | 2024-11-29 |