| NPI | 1518678143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN608240) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP026657) |
| Enumeration Date | 2022-12-05 |
| Last Update Date | 2022-12-20 |