| NPI | 1528138682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MD R145793) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R145793) |
| 171000000X Military Health Care Provider (Licence: MD R145793) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2019-07-15 |