| NPI | 1720962129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP034055) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: PA RN679585) |
| Enumeration Date | 2025-07-31 |
| Last Update Date | 2025-11-07 |