| NPI | 1356171763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: VA 0001277840) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001277840) |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2024-08-03 |