NPI | 1053943217 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 26046) |
Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: OK 200190) |
363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX AP144916) | |
Enumeration Date | 2020-02-06 |
Last Update Date | 2022-05-26 |