| NPI | 1841855285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN203020) |
| Additional Taxonomies | 207PE0004X Emergency Medicine Emergency Medical Services (Licence: GA RN203020) |
| 363LF0000X Nurse Practitioner Family (Licence: GA RN203020) | |
| Enumeration Date | 2019-05-01 |
| Last Update Date | 2021-05-15 |