| NPI | 1508509191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: NH 111503-23) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: NH 111503-23) |
| 363LF0000X Nurse Practitioner Family (Licence: WV 112582) | |
| Enumeration Date | 2022-04-20 |
| Last Update Date | 2024-08-27 |