| NPI | 1750279691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MD R244850) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: DE LP-0010917) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: DE LP-0010917) | |
| Enumeration Date | 2025-06-27 |
| Last Update Date | 2026-06-03 |