| NPI | 1356965255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN296585) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CO RN.0201695) |
| Enumeration Date | 2020-06-05 |
| Last Update Date | 2021-09-28 |