| NPI | 1871394759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: PA SP033001) |
| Additional Taxonomies | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: PA SP033001) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP033001) | |
| Enumeration Date | 2025-03-24 |
| Last Update Date | 2025-09-04 |