| NPI | 1588554901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 205847) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: LA 205847) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA 205847) | |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2025-07-07 |