| NPI | 1639826373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN259795) |
| Additional Taxonomies | 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: GA NCO-000001) |
| Enumeration Date | 2022-03-02 |
| Last Update Date | 2022-10-20 |