| NPI | 1942098694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5023124) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 286330) |
| Enumeration Date | 2025-04-30 |
| Last Update Date | 2025-12-04 |