| NPI | 1679243950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: DC NP1037841) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: DC RN1037841) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024182840) | |
| Enumeration Date | 2021-09-17 |
| Last Update Date | 2023-11-22 |