| NPI | 1194580795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 14094) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CT 154019) |
| Enumeration Date | 2024-02-14 |
| Last Update Date | 2024-12-05 |