| NPI | 1740803303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 15708) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WI 15708) |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2025-07-01 |