| NPI | 1154270379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP270177) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0024195973) |
| Enumeration Date | 2026-01-22 |
| Last Update Date | 2026-01-22 |