| NPI | 1821983701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner Primary Care (Licence: MD R191841) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: MD R191841) |
| Enumeration Date | 2025-06-11 |
| Last Update Date | 2025-08-07 |