| NPI | 1841999265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: PA SP028127) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: WV 115734) |
| Enumeration Date | 2023-02-24 |
| Last Update Date | 2024-05-14 |