| NPI | 1881884336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP010357) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA sp010357) |
| 363L00000X Nurse Practitioner (Licence: NY F3352841) | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2021-03-05 |