| NPI | 1528129376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP008831) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP008831) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MD R150406) | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2024-11-22 |