| NPI | 1548884455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 27577) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TN 189618) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2020-06-05 |