| NPI | 1144771361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: PA SP016916) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016916) |
| Enumeration Date | 2016-10-24 |
| Last Update Date | 2021-09-22 |