| NPI | 1841740313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: VA 0024190190) |
| Additional Taxonomies | 2084A2900X Psychiatry & Neurology Neurocritical Care (Licence: VA 0024190190) |
| Enumeration Date | 2016-10-10 |
| Last Update Date | 2024-08-14 |