| NPI | 1124751110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP001339) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-137953) |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2023-10-31 |