| NPI | 1275588071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN153940) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN153940) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN153940) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2024-08-06 |