| NPI | 1003291378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN276837) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TN 20223) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NC 5007870) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 20223) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5007870) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 281623) | |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2019-01-28 |