| NPI | 1457006025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP024906) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP024906) |
| 363LC1500X Nurse Practitioner, Community Health (Licence: PA SP024906) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP024906) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP024906) | |
| Enumeration Date | 2022-02-13 |
| Last Update Date | 2022-12-20 |