| NPI | 1710803192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11036973) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL 11036973) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 11036973) | |
| Enumeration Date | 2026-06-29 |
| Last Update Date | 2026-06-29 |