| NPI | 1194081588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MD R193426) |
| Additional Taxonomies | 364SC0200X Clinical Nurse Specialist, Critical Care Medicine (Licence: MD CS00100) |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2020-10-14 |