| NPI | 1285662486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN109950) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1066794) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: AL 1066794) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2015-07-30 |