| NPI | 1922557909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: TN 21648) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: TN APN0000021648) |
| Enumeration Date | 2016-10-01 |
| Last Update Date | 2017-04-07 |