| NPI | 1356529101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN201832 NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN201832NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NJ00153300) | |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2018-03-17 |