| NPI | 1730967936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 11028691) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN11028691) |
| Enumeration Date | 2023-09-19 |
| Last Update Date | 2023-12-14 |