| NPI | 1922416288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN175854) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: SC 18954) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2020-09-25 |