| NPI | 1790293678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MT MED-APRN-REG-0001736) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 56098) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: CT 009284) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 25396) | |
| 363L00000X Nurse Practitioner (Licence: MT NUR-APRN-LIC-170460) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TX AP136184) | |
| Enumeration Date | 2018-01-13 |
| Last Update Date | 2024-08-07 |