| NPI | 1790599157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP032104) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA MD9481196) |
| Enumeration Date | 2025-02-05 |
| Last Update Date | 2025-04-30 |