| NPI | 1790186799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: ID NP-1496A) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: MT 161744) |
| Enumeration Date | 2014-09-09 |
| Last Update Date | 2020-10-20 |