| NPI | 1902461601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MN 6693) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MN 6693) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2024-06-19 |