| NPI | 1841850500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN238216) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN238216) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN238216) | |
| Enumeration Date | 2019-06-15 |
| Last Update Date | 2020-03-22 |