| NPI | 1174221469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN284014) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA RN284014) |
| Enumeration Date | 2023-02-16 |
| Last Update Date | 2024-08-16 |