| NPI | 1265753941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA SP016543) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN598241) |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2019-01-30 |