| NPI | 1306330691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: AZ AP11409) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432531) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: AZ AP11409) | |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2025-02-04 |