| NPI | 1992848568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: VA 0024171153) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NY 300159) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024171153) | |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2015-01-20 |