| NPI | 1407247158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN199709) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN199709) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN199709) | |
| 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: GA RN199709) | |
| Enumeration Date | 2015-02-16 |
| Last Update Date | 2018-08-28 |