| NPI | 1649822966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP020516) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN665722) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP020516) | |
| Enumeration Date | 2019-07-16 |
| Last Update Date | 2026-01-13 |