| NPI | 1225177868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: NC 222354) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: GA RN117112NP) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2021-04-01 |