| NPI | 1063175495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL 11016115) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11016115) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 11016115) | |
| Enumeration Date | 2021-10-21 |
| Last Update Date | 2022-11-16 |