| NPI | 1659968295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: TX 1101696) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: GA RN257320) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN257320) | |
| Enumeration Date | 2020-12-29 |
| Last Update Date | 2024-03-29 |