| NPI | 1033771860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN210540) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA RN210540) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2020-10-22 |