| NPI | 1669538245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: GA RN181652 NP) |
| Additional Taxonomies | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: GA RN181652NP) |
| 363LA2100X Nurse Practitioner Acute Care (Licence: AL 1-088939) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2022-07-20 |