| NPI | 1164941415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN318848) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95007584) |
| Enumeration Date | 2017-09-18 |
| Last Update Date | 2023-06-08 |