| NPI | 1467011213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN232844) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 23295) |
| Enumeration Date | 2019-06-06 |
| Last Update Date | 2023-09-19 |