| NPI | 1063368504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA APRN-NP299550) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA NP299550) |
| Enumeration Date | 2026-03-06 |
| Last Update Date | 2026-07-07 |