| NPI | 1780201897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP022253) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA AG06200180) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2021-02-22 |