| NPI | 1215744990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: NM 90733) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NM RN80646) |
| Enumeration Date | 2024-12-16 |
| Last Update Date | 2026-07-27 |