| 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 |