| NPI | 1194387373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95012017) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95012017) |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2020-08-17 |