| NPI | 1730103508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA VP004696B) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN310329L) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2021-03-17 |