| NPI | 1942893284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WI 10446) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WI 10446) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-11-10 |