| NPI | 1578597100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013788) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 69312) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2019-12-16 |