| NPI | 1871074518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP019142) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN661127) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2021-09-22 |