| NPI | 1699959403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP009683) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP009683) |
| Enumeration Date | 2007-12-28 |
| Last Update Date | 2021-05-07 |