| NPI | 1821862376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA APRN-NP284003) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN284003) |
| Enumeration Date | 2023-11-14 |
| Last Update Date | 2025-12-24 |