| NPI | 1720799091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WV 114813) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA 114813) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WV 114813) | |
| Enumeration Date | 2022-12-07 |
| Last Update Date | 2023-07-19 |