| NPI | 1609177708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NC 5008726) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 201050219NP) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 19960) | |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2017-02-02 |