| NPI | 1275085508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN216852) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN216852) |
| Enumeration Date | 2016-11-03 |
| Last Update Date | 2021-05-21 |