| NPI | 1104696392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse Critical Care Medicine (Licence: SC 274555) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NY 799859) |
| Enumeration Date | 2024-01-08 |
| Last Update Date | 2024-01-09 |