| NPI | 1285904383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA APRN-NP209698) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY F311457-01) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2026-03-03 |