| NPI | 1114651049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP314309) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 802840) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432363) | |
| 163W00000X Registered Nurse (Licence: GA 313409) | |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2025-10-31 |