| NPI | 1871956680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: NH 055355-23) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: VT 101.0118606) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2016-03-30 |