| NPI | 1497936652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: DE LP-0010395) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0031700) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: DE LB-0000204) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: DE LB-0000204) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2022-08-16 |