| NPI | 1376962662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP022513) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: PA SP013650) |
| Enumeration Date | 2014-04-15 |
| Last Update Date | 2023-12-20 |