| NPI | 1114767043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN299635) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN299635) |
| 364SE0003X Clinical Nurse Specialist, Emergency (Licence: GA RN299635) | |
| Enumeration Date | 2024-05-29 |
| Last Update Date | 2026-05-14 |