| NPI | 1992287700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA GAA-NP004200) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL ARNP907759) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL ARNP907759) | |
| 363L00000X Nurse Practitioner (Licence: FL ARNP907759) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA GAA-NP004200) | |
| Enumeration Date | 2018-08-29 |
| Last Update Date | 2026-01-08 |