| NPI | 1104422666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD AC003463) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: DE L1-0040548) |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2021-03-15 |