| NPI | 1316667025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: VA 0024184972) |
| Additional Taxonomies | 207LC0200X Anesthesiology Critical Care Medicine (Licence: VA 0024184972) |
| Enumeration Date | 2022-09-01 |
| Last Update Date | 2023-08-25 |