| NPI | 1316605587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN288232) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN288232) |
| Enumeration Date | 2021-12-03 |
| Last Update Date | 2022-04-11 |