| NPI | 1508213083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: PA RN646455) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: PA SP016342) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2021-04-09 |