| NPI | 1275588071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP153940) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA APRN-NP153940) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA APRN-NP153940) | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2025-10-14 |