| NPI | 1174047740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN191137) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: GA RN191137) |
| Enumeration Date | 2017-07-26 |
| Last Update Date | 2024-10-07 |