| NPI | 1235607730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NV 812452) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NV 812452) |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-09 |