| NPI | 1285477018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS F07250420) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MS 918907) |
| Enumeration Date | 2024-06-18 |
| Last Update Date | 2025-07-16 |