| NPI | 1477912756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP019999) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN622719) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2019-08-05 |