| NPI | 1275167058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP021546) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP021546) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2023-02-01 |