| NPI | 1023353596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP012477) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F306250-1) |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2021-03-18 |