| NPI | 1548717556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: PA SP017561) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE L1-0043007) |
| 363L00000X Nurse Practitioner (Licence: DE LP-0000181) | |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: DE LP-0000181) | |
| Enumeration Date | 2016-09-07 |
| Last Update Date | 2022-07-21 |