| NPI | 1043620669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP029731) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA RN703306) |
| 363L00000X Nurse Practitioner (Licence: PA SP022125) | |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP022125) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2025-01-30 |