| NPI | 1568608982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP010115) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MD R198767) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2015-12-24 |