| NPI | 1063106318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA 230755) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: LA AP230755) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: LA AP230755) | |
| Enumeration Date | 2023-06-07 |
| Last Update Date | 2023-08-01 |