| NPI | 1043851983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: DC RN1037957) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: DC RN1037957) |
| Enumeration Date | 2019-10-02 |
| Last Update Date | 2019-11-08 |