| NPI | 1093421547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA 00000) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN224620) |
| Enumeration Date | 2023-01-27 |
| Last Update Date | 2023-09-21 |