| NPI | 1023516911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: ID 57638) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: ID 47778) |
| Enumeration Date | 2018-01-25 |
| Last Update Date | 2020-12-23 |