| NPI | 1487100491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 5009435) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN224686) |
| Enumeration Date | 2016-08-30 |
| Last Update Date | 2023-10-16 |