| NPI | 1235739376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN248792) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN248792) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: GA RN248792) | |
| 163WE0003X Registered Nurse, Emergency (Licence: GA RN248792) | |
| 363L00000X Nurse Practitioner (Licence: GA RN248792) | |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN248792) | |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2022-12-29 |