| 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 |