| NPI | 1134703705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN242817) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: GA RN242817) |
| Enumeration Date | 2021-05-10 |
| Last Update Date | 2022-12-16 |