| NPI | 1215079736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN225443) |
| Additional Taxonomies | 208600000X Surgery (Licence: GA RN225443) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2018-03-26 |