| NPI | 1295402089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: ID 69540) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: ID 45067) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2021-08-30 |