| NPI | 1366956823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN299322) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MN 5539) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2021-10-05 |