| NPI | 1457809881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NH 077205-23) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: OH RN.372827) |
| 363L00000X Nurse Practitioner (Licence: NH 077205-23) | |
| Enumeration Date | 2016-09-14 |
| Last Update Date | 2018-03-20 |