| NPI | 1144681016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN220963) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA rn220963) |
| Enumeration Date | 2016-03-18 |
| Last Update Date | 2025-01-29 |