| NPI | 1053798967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WI 13802) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP7762) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ AP7762) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2023-07-10 |