| NPI | 1275803108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN228991) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AL CRNP 1-114327) |
| Enumeration Date | 2012-01-10 |
| Last Update Date | 2020-09-11 |