| NPI | 1912723305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: FL 11037436) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9522986) |
| Enumeration Date | 2024-12-02 |
| Last Update Date | 2025-01-31 |