| NPI | 1053943217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP144916) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 26046) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX AP144916) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: OK 200190) | |
| Enumeration Date | 2020-02-06 |
| Last Update Date | 2025-02-04 |