| NPI | 1013647817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WC0200X Registered Nurse Critical Care Medicine (Licence: MO 2021016270) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: MO 2021016270) |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2022-06-14 |