| NPI | 1528565132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA APRN-NP294524) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MT 130004) |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: MT 130004) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN294524) | |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2025-10-10 |