| NPI | 1225420482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP018152) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 19176) |
| Enumeration Date | 2015-02-25 |
| Last Update Date | 2019-09-26 |