| NPI | 1306396254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN177979) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11008560) |
| Enumeration Date | 2016-10-04 |
| Last Update Date | 2025-07-01 |