| NPI | 1154989457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-116056) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN288946) |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2019-10-24 |