| NPI | 1518492008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP017303) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 341667) |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2021-03-30 |