| NPI | 1467833459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016031) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95002513) |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2026-06-12 |