| NPI | 1659045839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP024434) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN685015) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2022-09-27 |