| NPI | 1518037217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP008341) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: PA RN528411L) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2023-03-16 |