| NPI | 1740911163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN236477) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN236477) |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2022-06-28 |