| NPI | 1649018284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP031459) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN711506) |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-12-11 |