| NPI | 1114558889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN258361) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: GA RN258361) |
| Enumeration Date | 2020-01-30 |
| Last Update Date | 2020-01-30 |