| NPI | 1689345779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: MN 8470) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: MN 2026383) |
| Enumeration Date | 2021-09-28 |
| Last Update Date | 2021-11-09 |