| NPI | 1851842652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN220604) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN220604) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN220604) | |
| Enumeration Date | 2016-10-18 |
| Last Update Date | 2022-07-21 |