| NPI | 1114047792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP008899) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00110200) |
| 163W00000X Registered Nurse (Licence: PA RN569452) | |
| 163W00000X Registered Nurse (Licence: NJ 26NO12037000) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2015-08-10 |