| NPI | 1922386705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP017579) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9272686) |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP017579) | |
| Enumeration Date | 2011-07-28 |
| Last Update Date | 2023-04-04 |