| NPI | 1962046110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CA 95023352) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP020980) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP020980) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NJ 26NJ01234000) | |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2023-08-08 |