| NPI | 1326605056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP020237) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: PA RN620605) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2019-05-29 |