NPI | 1124610928 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD R224708) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R224708) |
Enumeration Date | 2021-02-03 |
Last Update Date | 2021-02-18 |