| NPI | 1417345638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN244491) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 19277) |
| Enumeration Date | 2014-12-23 |
| Last Update Date | 2019-02-07 |