| NPI | 1134670474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN221151) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: GA 221151) |
| Enumeration Date | 2016-10-21 |
| Last Update Date | 2025-03-14 |