| NPI | 1023151909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: GA RN168858) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN168858) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2012-10-01 |