| NPI | 1336707124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN230145) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN230145) |
| Enumeration Date | 2019-06-05 |
| Last Update Date | 2025-10-15 |