| NPI | 1831944123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN290487) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN290487) |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2025-10-24 |