| NPI | 1033497771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP018994) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TX 733191) |
| 363LF0000X Nurse Practitioner Family (Licence: MD R219135) | |
| 363LP2300X Nurse Practitioner Primary Care (Licence: TX 733191) | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2022-07-21 |