| NPI | 1003484957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TX 1048614) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TX 973672) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-07-28 |