| NPI | 1962917120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP018236) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP018236) |
| Enumeration Date | 2017-12-11 |
| Last Update Date | 2024-11-05 |