| NPI | 1073047478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN226432) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN226432) |
| 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN226432) | |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2017-05-05 |