| NPI | 1558125369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN283195) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN283195) |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2025-11-20 |