| NPI | 1942784012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP019260) |
| Additional Taxonomies | 363LS0200X Nurse Practitioner, School (Licence: PA SP019260) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2021-10-05 |