| NPI | 1518749290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: IN 71014525A) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: IN 28157595A) |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2024-02-06 |