| NPI | 1750981858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP022869) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN617227) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2024-01-02 |