| NPI | 1801381561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP019045) |
| Additional Taxonomies | 163WG0600X Registered Nurse, Gerontology (Licence: PA RN648252) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2018-08-10 |