| NPI | 1710684428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN289159) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN289159) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GA 2023000291) | |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-05-24 |