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 |