| NPI | 1689982043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 15166) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WI 17073430) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2024-04-01 |