| NPI | 1376928713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016105) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV APRN001976) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2017-11-01 |