| NPI | 1376307272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: CA 95033994) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH 0036674) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA 95033994) | |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2025-07-14 |