| NPI | 1285631887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN128712) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN128712) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN128712) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN128712) | |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2021-02-05 |