| NPI | 1427845049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP302541) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN302541) |
| Enumeration Date | 2025-04-24 |
| Last Update Date | 2025-10-08 |