| NPI | 1083072367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN253827) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA NCO-000003) |
| Enumeration Date | 2016-02-02 |
| Last Update Date | 2021-07-30 |