| NPI | 1366878746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013195) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA SP013195) |
| Enumeration Date | 2013-09-17 |
| Last Update Date | 2021-04-19 |