| NPI | 1649822966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020516) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN665722) |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2019-07-22 |