| NPI | 1023767910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: ID 58505) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: ID 58505) |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2022-06-20 |