| NPI | 1700483351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2278C0205X Respiratory Therapist, Certified, Critical Care |
| Additional Taxonomies | 103TP0016X Psychologist, Prescribing (Medical) |
| 261QE0002X Clinic/Center, Emergency Care | |
| Enumeration Date | 2020-10-07 |
| Last Update Date | 2020-10-07 |