| NPI | 1346912649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DC NP1045161) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: DC 1045161) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2022-03-13 |