| NPI | 1588122030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: MD r204081) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MD r204081) |
| Enumeration Date | 2019-03-04 |
| Last Update Date | 2019-03-04 |