| NPI | 1043029648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN274769) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: GA RN274769) |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-04-28 |