| NPI | 1831944123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN290487) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: GA RN290487) |
| 207LC0200X Anesthesiology, Critical Care Medicine (Licence: GA RN290487) | |
| Enumeration Date | 2024-04-19 |
| Last Update Date | 2024-10-03 |