| NPI | 1770345662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MO 2024002946) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: MO 2024002946) |
| Enumeration Date | 2024-01-25 |
| Last Update Date | 2024-01-25 |