| NPI | 1801248489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner Acute Care (Licence: GA RN222625) |
| Additional Taxonomies | 163WR0006X Registered Nurse Registered Nurse First Assistant (Licence: GA RN222625) |
| 363LG0600X Nurse Practitioner Gerontology (Licence: GA RN222625) | |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2025-08-26 |