| NPI | 1114666708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA APRN-NP268836) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: GA RN268836) |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2026-04-02 |