| NPI | 1235695990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN248151) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN248151) |
| Enumeration Date | 2019-02-18 |
| Last Update Date | 2021-08-26 |