| NPI | 1346832052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 32428) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000212737) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN300745) | |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2023-08-29 |