| NPI | 1366994881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP015866) |
| Additional Taxonomies | 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: PA SP015866) |
| Enumeration Date | 2016-11-01 |
| Last Update Date | 2024-10-15 |