| NPI | 1851722193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013437) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016394) |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2021-07-19 |