| NPI | 1487001798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN202887) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN202887) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN202887) | |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2024-09-10 |