| NPI | 1407715634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN332960) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AZ 343414) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA APRN-NP332960) | |
| Enumeration Date | 2026-01-22 |
| Last Update Date | 2026-08-30 |