| NPI | 1386985513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP012742) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: PA SP012742) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2016-03-13 |