| NPI | 1295206712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TN 000221613) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TN 221613) |
| Enumeration Date | 2018-12-10 |
| Last Update Date | 2018-12-10 |