| NPI | 1699499467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 11260) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CT 140147) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2024-05-10 |