| NPI | 1427178599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA TP004910D) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA TP004910D) |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA TP004910D) | |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2025-01-29 |