| NPI | 1396355327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: PA SP022592) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner Adult Health (Licence: NY 309784) |
| Enumeration Date | 2020-08-04 |
| Last Update Date | 2023-12-04 |