| NPI | 1326596875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MI 4704329442) |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: MI 4703115986) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2019-11-13 |