| NPI | 1992327282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC MANE-1SABA) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 283928) |
| Enumeration Date | 2020-05-11 |
| Last Update Date | 2020-08-07 |