| NPI | 1861008393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN250045) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA RN250045) |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: GA RN250045) | |
| Enumeration Date | 2020-09-21 |
| Last Update Date | 2024-02-15 |