| NPI | 1093838898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: TN 16875) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: MO 2006007241) |
| Enumeration Date | 2007-04-08 |
| Last Update Date | 2022-12-29 |