| NPI | 1912548322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN311161) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 873044) |
| Enumeration Date | 2019-10-07 |
| Last Update Date | 2024-02-14 |