| NPI | 1891237814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN209392) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN209392) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN209392) | |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2023-07-28 |