| NPI | 1265162622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN307511) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN307511) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2022-12-06 |