| NPI | 1487147922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP018835) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP018835) |
| Enumeration Date | 2018-06-10 |
| Last Update Date | 2026-01-12 |