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 |