| NPI | 1124006200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AK 121442) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA rn144697) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2025-08-06 |