| NPI | 1205658713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA NP319607) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN319607) |
| Enumeration Date | 2024-10-26 |
| Last Update Date | 2026-07-10 |