| NPI | 1306212840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704256408) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MI 4704256408) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2015-09-16 |