| NPI | 1588338826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: TX 939556) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: TX 939556) |
| Enumeration Date | 2021-08-02 |
| Last Update Date | 2021-08-02 |