| NPI | 1093415788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA APRN-NP236767) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP236767) |
| Enumeration Date | 2023-03-09 |
| Last Update Date | 2025-10-27 |