| NPI | 1457806184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN209728) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN209728) |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2020-08-19 |