| NPI | 1013745884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP030632) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN701020) |
| Enumeration Date | 2024-07-23 |
| Last Update Date | 2024-10-04 |