| NPI | 1962046318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5016073) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 262403) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 26403) | |
| Enumeration Date | 2019-10-29 |
| Last Update Date | 2022-08-16 |