| NPI | 1679176390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WI 82441-30) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WI 82441-30) |
| Enumeration Date | 2020-11-17 |
| Last Update Date | 2020-12-11 |