| NPI | 1396079042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN147732) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN147732NP) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2023-07-25 |