| NPI | 1063858819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN084674) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN RN0000067661) |
| Enumeration Date | 2013-05-21 |
| Last Update Date | 2013-05-21 |