| NPI | 1730936022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL 11035668) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: FL 11035668) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 11035668) | |
| Enumeration Date | 2024-05-03 |
| Last Update Date | 2024-10-04 |