| NPI | 1396274072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 1-118142) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN202209) |
| Enumeration Date | 2017-06-07 |
| Last Update Date | 2022-06-07 |