| NPI | 1164065884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN260086) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN260086) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2023-10-27 |