| NPI | 1801251996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN251372) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN251372) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN251372) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GA RN251372) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN251372) | |
| 363L00000X Nurse Practitioner (Licence: GA RN251372) | |
| Enumeration Date | 2015-12-16 |
| Last Update Date | 2023-10-25 |