| NPI | 1093470759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: DC NP1002219) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 184823) |
| Enumeration Date | 2021-11-07 |
| Last Update Date | 2022-09-20 |