| NPI | 1174343685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: OR 10034043) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: OR 10034043) |
| Enumeration Date | 2024-10-10 |
| Last Update Date | 2024-10-10 |