| NPI | 1720548225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 25635) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: TN 25635) |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2024-04-24 |