| NPI | 1750034682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN283498) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN283498) |
| Enumeration Date | 2022-01-31 |
| Last Update Date | 2022-11-06 |