| NPI | 1447877956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP024057) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN694917) |
| 207Q00000X Family Medicine (Licence: PA SP024057) | |
| Enumeration Date | 2020-06-30 |
| Last Update Date | 2023-10-30 |