| NPI | 1982384780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: PA SP027813) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: PA SP027813) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: PA SP027813) | |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2023-11-07 |