| NPI | 1639824477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: GA NP000585) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner Acute Care (Licence: GA GAA-NP000585) |
| Enumeration Date | 2022-02-21 |
| Last Update Date | 2024-01-17 |