| NPI | 1568035681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN275424) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN275424) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2024-01-15 |