| NPI | 1609205376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 002417141323) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0001245175) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0015000967) | |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: VA 0024171264) | |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2024-12-24 |