| NPI | 1609473222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP022783) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN667448) |
| Enumeration Date | 2020-10-06 |
| Last Update Date | 2025-03-18 |