| NPI | 1295893204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN187417) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN APN0000012398) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2023-11-27 |