| NPI | 1689824583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WI 3515) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 3515-33) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2026-07-27 |