| NPI | 1003918392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP009092) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP009092) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024165512) | |
| Enumeration Date | 2006-09-05 |
| Last Update Date | 2023-04-04 |