| NPI | 1124975354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: IN 71017978A) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: IN 28207936A) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: IN 71017978A) | |
| Enumeration Date | 2026-03-16 |
| Last Update Date | 2026-06-03 |