| NPI | 1437947348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP032785) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN728353) |
| Enumeration Date | 2025-04-29 |
| Last Update Date | 2025-06-28 |