| NPI | 1992391346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA rn244849) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA rn244849) |
| Enumeration Date | 2020-12-18 |
| Last Update Date | 2022-06-28 |