| NPI | 1952631103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: OR 201802343NP-PP) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 6259325-4405) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: UT 6259325-8900) | |
| Enumeration Date | 2010-01-12 |
| Last Update Date | 2018-03-30 |