| NPI | 1407137607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-112121) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN229397) |
| Enumeration Date | 2011-08-31 |
| Last Update Date | 2019-02-04 |