| NPI | 1366043051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WI 11740) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WI 11740-33) |
| Enumeration Date | 2020-11-08 |
| Last Update Date | 2022-05-26 |