| NPI | 1629485826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN197164) |
| Additional Taxonomies | 364SA2100X Clinical Nurse Specialist, Acute Care (Licence: GA RN197164) |
| Enumeration Date | 2014-07-20 |
| Last Update Date | 2014-07-20 |