| NPI | 1437554235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: OR 201600814NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MN R 220478-1) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 5970-33) | |
| Enumeration Date | 2014-10-23 |
| Last Update Date | 2023-09-22 |