| NPI | 1740684638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP014352) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP014352) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA RN591486) | |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2020-12-15 |