| NPI | 1558091710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MA RN2321425) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN2321425) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95240319) | |
| Enumeration Date | 2022-06-12 |
| Last Update Date | 2022-08-06 |