NPI | 1093415788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA RN236767) |
Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN236767) |
Enumeration Date | 2023-03-09 |
Last Update Date | 2023-03-21 |