| NPI | 1588631873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP017755) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN502050L) |
| Enumeration Date | 2006-03-05 |
| Last Update Date | 2017-12-13 |