| NPI | 1689200941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: CT 8844) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: CT 146945) |
| Enumeration Date | 2020-03-19 |
| Last Update Date | 2020-05-01 |