| NPI | 1669987780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP018175) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NJ 26NJ00788000) |
| Enumeration Date | 2017-12-12 |
| Last Update Date | 2018-08-01 |