| NPI | 1407227994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN188500) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: WI 15475) |
| Enumeration Date | 2015-10-09 |
| Last Update Date | 2024-08-21 |