| NPI | 1023425600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP021669) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11004127) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP021669) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2021-04-16 |