| NPI | 1689310187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NC 5016468) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NC 297027) |
| Enumeration Date | 2022-05-08 |
| Last Update Date | 2023-12-07 |