| NPI | 1073252854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP026008) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA RN584989) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2022-12-20 |