| NPI | 1174111637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NC 2020005812) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NC 5014028) |
| Enumeration Date | 2021-01-08 |
| Last Update Date | 2021-02-07 |