| NPI | 1477522308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP004897C) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP004897C) |
| 363L00000X Nurse Practitioner (Licence: NY F302276-1) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2021-03-11 |