| NPI | 1003450057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP021086) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R213165) |
| 163W00000X Registered Nurse (Licence: PA RN669437) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R213165) | |
| Enumeration Date | 2019-11-03 |
| Last Update Date | 2023-07-13 |