| NPI | 1144066861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN291774) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: GA RN291774) |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2025-03-26 |