| NPI | 1417680984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CT 10744) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CT 10.120090) |
| Enumeration Date | 2022-07-02 |
| Last Update Date | 2023-02-13 |