| NPI | 1912570128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP024036) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: PA SP024036) |
| Enumeration Date | 2021-07-24 |
| Last Update Date | 2023-08-24 |