| NPI | 1689000101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA RN210166) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP9290091) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2022-11-10 |