| NPI | 1427640713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP022686) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN624174) |
| Enumeration Date | 2021-02-08 |
| Last Update Date | 2022-09-21 |