| NPI | 1902556848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 311879) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN749716) |
| 163W00000X Registered Nurse (Licence: GA RN280809) | |
| 363L00000X Nurse Practitioner (Licence: GA RN280809) | |
| 363L00000X Nurse Practitioner (Licence: PA SP025728) | |
| Enumeration Date | 2022-03-24 |
| Last Update Date | 2024-10-04 |