| NPI | 1952786295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP015141) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: PA SP015141) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: PA SP015141) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2018-09-28 |