| NPI | 1275415580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: WV 108310) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WV 108310) |
| Enumeration Date | 2025-07-25 |
| Last Update Date | 2025-10-27 |