| NPI | 1427368943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN APN15251) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN166076) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2024-01-12 |