| NPI | 1558116749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: LA 224002469) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: AL 1-176301) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-04-22 |