| NPI | 1992137517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013113) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN290896L) |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2021-04-09 |