| NPI | 1205424397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: LA 225017) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: IN 71010809A) |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: OH APRN.CNP.0027088) | |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2022-08-04 |