| NPI | 1396348280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA F09201627) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN244697) |
| Enumeration Date | 2020-11-21 |
| Last Update Date | 2022-09-20 |