| NPI | 1962015578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: ND R36429) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: ND R36429CNP) |
| 363L00000X Nurse Practitioner (Licence: ND R36429) | |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2022-10-31 |