| NPI | 1881430270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5022945) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 278216) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 37078) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NC 5022945) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5022945) | |
| Enumeration Date | 2024-07-04 |
| Last Update Date | 2026-01-26 |