| NPI | 1679277768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN302624) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN302624) |
| Enumeration Date | 2023-03-30 |
| Last Update Date | 2024-09-27 |