| NPI | 1477984813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013471) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA MU3095660) |
| Enumeration Date | 2013-12-11 |
| Last Update Date | 2025-01-23 |