NPI | 1982256772 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: GA RN232002) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN232002) |
Enumeration Date | 2019-07-11 |
Last Update Date | 2023-02-14 |