| NPI | 1326425935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: UT 10237129-4405) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ AP7758) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP7758) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ AP7758) | |
| Enumeration Date | 2015-05-04 |
| Last Update Date | 2021-03-26 |