| NPI | 1437501368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000021010) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN154680) |
| Enumeration Date | 2016-07-03 |
| Last Update Date | 2024-01-24 |