| NPI | 1083262075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP021010) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN563072) |
| Enumeration Date | 2019-09-03 |
| Last Update Date | 2020-02-18 |