| NPI | 1437596699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013584) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN585298PA) |
| Enumeration Date | 2013-05-29 |
| Last Update Date | 2023-03-07 |