| NPI | 1194333500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: VA 0024179889) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: VA 0001260076) |
| Enumeration Date | 2020-07-22 |
| Last Update Date | 2021-07-14 |