| NPI | 1295936532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP011170) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN563119) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2011-03-09 |