| NPI | 1659748077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN218021) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA APRN-NP218021) |
| Enumeration Date | 2015-09-02 |
| Last Update Date | 2025-11-04 |