| NPI | 1457827891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP019752) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA TLRN054098) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2024-07-01 |