| NPI | 1306491147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP020575) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: PA SP020575) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP020575) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP020575) | |
| Enumeration Date | 2019-08-08 |
| Last Update Date | 2021-01-27 |