| NPI | 1023481199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9436544) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN000000) |
| Enumeration Date | 2015-11-11 |
| Last Update Date | 2018-04-19 |