| NPI | 1134546831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN199165) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA RN199165) |
| Enumeration Date | 2014-03-20 |
| Last Update Date | 2025-01-22 |