| NPI | 1679957799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 9308293) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NE 49831) |
| 364SC0200X Clinical Nurse Specialist, Critical Care Medicine (Licence: NE 114086) | |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2015-07-18 |