| NPI | 1376062117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020089) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9373278) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9373278) | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2020-03-19 |