| NPI | 1346008877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN334335) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R265483) |
| 363LF0000X Nurse Practitioner, Family (Licence: MD R265483) | |
| Enumeration Date | 2024-03-11 |
| Last Update Date | 2025-07-15 |