| NPI | 1609691781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NH 075745-23) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NH 075745-21) |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2025-04-20 |