| NPI | 1508745688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP034084) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP034084) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP034084) | |
| Enumeration Date | 2025-09-02 |
| Last Update Date | 2025-10-07 |