| NPI | 1891142774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP016600) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA 2016001828) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA F0516014) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00684300) | |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2023-05-25 |