| NPI | 1255199907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: ND R46122) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: ND R46122) |
| 163WE0003X Registered Nurse Emergency (Licence: ND R46122) | |
| Enumeration Date | 2024-03-07 |
| Last Update Date | 2025-06-13 |