| NPI | 1922529577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP017780) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA RN561216) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2024-12-09 |