| NPI | 1659910800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner Critical Care Medicine (Licence: GA RN259503) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN259503) |
| Enumeration Date | 2020-01-04 |
| Last Update Date | 2021-10-05 |