| NPI | 1962634659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP010360) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA sp010360) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: PA SP010360) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP010360) | |
| Enumeration Date | 2009-08-14 |
| Last Update Date | 2023-04-20 |