| NPI | 1912791419 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: FL 9679164) | 
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL 9679164) | 
| Enumeration Date | 2025-04-08 | 
| Last Update Date | 2025-04-08 |