| NPI | 1568791689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP010508) |
| Additional Taxonomies | 363LN0000X Nurse Practitioner, Neonatal (Licence: PA SP014838) |
| Enumeration Date | 2009-12-19 |
| Last Update Date | 2020-04-02 |