| NPI | 1801781042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP003760) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA GAA-NP003760) |
| 207P00000X Emergency Medicine (Licence: FL APRN11041775) | |
| Enumeration Date | 2025-06-10 |
| Last Update Date | 2025-12-10 |