| NPI | 1245949593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5017255) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC PITT-YU2WO) |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2024-11-14 |