| NPI | 1932457645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN231619) |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care (Licence: AL 1113691) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2014-09-04 |