| NPI | 1336765064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NY 431906) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209.021090) |
| Enumeration Date | 2020-06-18 |
| Last Update Date | 2021-04-01 |