| NPI | 1669208443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP030889) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN683177) |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2024-10-23 |