| NPI | 1013697267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024187479) |
| Additional Taxonomies | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: VA 0024187479) |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2026-05-11 |