| NPI | 1316415136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71008853A) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: OH 429527) |
| Enumeration Date | 2018-11-09 |
| Last Update Date | 2020-10-20 |