| NPI | 1093461220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 27213) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN270216) |
| Enumeration Date | 2022-02-25 |
| Last Update Date | 2025-07-17 |