| NPI | 1235812124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-178678) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP001538) |
| Enumeration Date | 2023-08-08 |
| Last Update Date | 2023-10-10 |