| NPI | 1295546661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704357443) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: MI 4704357743) |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2026-09-10 |