| NPI | 1982007340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: DC 1034720) |
| Enumeration Date | 2014-09-30 |
| Last Update Date | 2022-04-26 |