| NPI | 1932628484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP017959) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11013995) |
| Enumeration Date | 2017-09-15 |
| Last Update Date | 2026-06-23 |