| NPI | 1619434701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP020195) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA RN690267) |
| Enumeration Date | 2019-02-25 |
| Last Update Date | 2019-04-02 |