| NPI | 1235889445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: FL 11018892) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: FL 9424112) |
| Enumeration Date | 2022-03-29 |
| Last Update Date | 2022-03-29 |