| NPI | 1114666385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: OR 10059094) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ 278805) |
| Enumeration Date | 2022-06-03 |
| Last Update Date | 2026-08-12 |