| NPI | 1831078005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN711431) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: NC 5024599) |
| Enumeration Date | 2025-08-30 |
| Last Update Date | 2026-06-07 |