| NPI | 1225509573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN228894) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner Primary Care (Licence: GA RN228894) |
| Enumeration Date | 2018-12-16 |
| Last Update Date | 2023-11-25 |