| NPI | 1346041035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN335902) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA APRN-NP335902) |
| Enumeration Date | 2025-03-20 |
| Last Update Date | 2025-11-07 |