| NPI | 1356069769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN319054) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: NY 432397) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2024-07-17 |