| NPI | 1992173454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OK 210113) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WA RN 00150454) |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2022-08-30 |