| NPI | 1962918979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: PA SP018391) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP018391) |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2022-04-20 |