| NPI | 1700432861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP020514) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA SP020514) |
| 163W00000X Registered Nurse (Licence: PA RN645160) | |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2021-09-14 |