| NPI | 1447911839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CO 0997287) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CO 1627775) |
| Enumeration Date | 2022-01-07 |
| Last Update Date | 2025-10-02 |