| NPI | 1659124352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP029426) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP029426) |
| Enumeration Date | 2024-04-10 |
| Last Update Date | 2025-09-03 |