| NPI | 1841840956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP022914) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 152965) |
| 163W00000X Registered Nurse (Licence: PA RN735177) | |
| Enumeration Date | 2019-09-19 |
| Last Update Date | 2021-03-19 |