NPI | 1558980904 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP026026) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002003L) |
Enumeration Date | 2020-04-15 |
Last Update Date | 2024-12-26 |