| NPI | 1790176451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP021696) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP021696) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NJ 26NJ00831200) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: WA AP60771601) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9314752) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2022-03-29 |