| NPI | 1396289849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN162367) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: GA RN162367) |
| Enumeration Date | 2016-12-16 |
| Last Update Date | 2024-05-15 |