| NPI | 1801372081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP019244) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN619948) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2018-09-12 |