| NPI | 1629195003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP009214) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN504151L) |
| 363L00000X Nurse Practitioner (Licence: PA SP009214) | |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2017-06-26 |