| NPI | 1265927362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN209756) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN209756) |
| Enumeration Date | 2018-06-30 |
| Last Update Date | 2021-08-21 |