| NPI | 1710121959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 71003003A) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IN 71003003A) |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2024-01-08 |