| NPI | 1669831871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP015665) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: RI APRN00983) |
| Enumeration Date | 2016-02-16 |
| Last Update Date | 2019-10-17 |