| NPI | 1346982501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP025613) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN674797) |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2022-05-16 |