| NPI | 1083916225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP031382) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: PA CNS000164) |
| Enumeration Date | 2010-11-20 |
| Last Update Date | 2024-11-18 |