| NPI | 1780222158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: HI APRN-3542) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: AZ 235645) |
| 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: AZ 235645) | |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2022-07-27 |