| NPI | 1356744510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP014307) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN592302) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2020-02-20 |