| NPI | 1588014518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP017911) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN659434) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OR 201504233RN) | |
| Enumeration Date | 2016-06-21 |
| Last Update Date | 2017-10-09 |