| NPI | 1801354816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN284824) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 23306) |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2024-07-15 |