| NPI | 1053083501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN237023) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA pending) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2022-02-07 |