| NPI | 1235844424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN313506) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: SC 29347) |
| Enumeration Date | 2023-01-23 |
| Last Update Date | 2025-09-12 |