| NPI | 1689009953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN230991) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN230991) |
| 163WM0705X Registered Nurse, Medical-Surgical (Licence: GA RN230991) | |
| 163WX0800X Registered Nurse, Orthopedic (Licence: GA RN230991) | |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2021-03-03 |