| NPI | 1700021730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP009995) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN530752L) |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2020-04-06 |