| NPI | 1255996781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN174325) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 22830) |
| Enumeration Date | 2019-05-09 |
| Last Update Date | 2024-05-23 |