| NPI | 1912840505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: PA SP035454) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: OH APRN.CNP.0041351) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: CA NP95039025) | |
| Enumeration Date | 2026-04-10 |
| Last Update Date | 2026-08-18 |