| NPI | 1073207130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN233461) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA F06230144) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2023-06-05 |