| NPI | 1780340406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2337702) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: NY 701453) |
| Enumeration Date | 2021-11-17 |
| Last Update Date | 2021-11-17 |