| NPI | 1326062555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA VP004195B) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN245186L) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-08-17 |