| NPI | 1164002481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: GA 234604) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: GA 234604) |
| Enumeration Date | 2021-04-12 |
| Last Update Date | 2023-07-13 |