| NPI | 1306678255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11034886) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: FL 11034886) |
| 207RP1001X Internal Medicine, Pulmonary Disease (Licence: FL 11034886) | |
| Enumeration Date | 2024-08-19 |
| Last Update Date | 2025-06-09 |