| NPI | 1922655059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP020667) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP020667) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP020667) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: PA SP020667) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: PA SP020667) | |
| 363LX0001X Nurse Practitioner, Obstetrics & Gynecology (Licence: PA SP020667) | |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2019-08-22 |