| NPI | 1982554036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA APRN-NP281052) |
| Additional Taxonomies | 363LC0200X Nurse Practitioner, Critical Care Medicine (Licence: GA RN281052) |
| Enumeration Date | 2026-01-29 |
| Last Update Date | 2026-07-14 |