| NPI | 1841830817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP021124) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN592895) |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2021-10-12 |