| NPI | 1902218324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: IA H136852) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IL 209011352) |
| Enumeration Date | 2014-05-21 |
| Last Update Date | 2014-10-31 |