| NPI | 1922749332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN289321) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN289321) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: GA RN289321) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2023-10-12 |