| NPI | 1235503475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: ME CNP161216) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NY 545463) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: NJ 26NR11263800) | |
| Enumeration Date | 2015-11-28 |
| Last Update Date | 2021-03-03 |