| NPI | 1194252783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA RN293788) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN293788) |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2023-12-14 |