| NPI | 1083954317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R176700) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R176700) |
| Enumeration Date | 2013-02-23 |
| Last Update Date | 2014-02-07 |