| NPI | 1386226173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA RN221108) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN221108) |
| Enumeration Date | 2021-04-22 |
| Last Update Date | 2023-12-11 |