| NPI | 1750090882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA NCO-000003) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: SC 258290) |
| Enumeration Date | 2022-11-17 |
| Last Update Date | 2024-11-25 |