| NPI | 1235770702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP020925) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP020925) |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2026-02-03 |