| NPI | 1801804125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: GA RN112930) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: GA 004354) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |