| NPI | 1164538013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA UP-005801) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA 363LA2200X) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-06-18 |