NPI | 1134961402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MN 11711) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2436407) |
Enumeration Date | 2024-06-08 |
Last Update Date | 2024-07-10 |