| NPI | 1245988583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN235503) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA RN235503) |
| Enumeration Date | 2022-03-15 |
| Last Update Date | 2022-08-04 |