| NPI | 1144465600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R195446) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 92785) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA RN535363) | |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP010011) | |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2019-09-24 |