NPI | 1497798565 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN224765) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 12467) |
363L00000X Nurse Practitioner (Licence: GA RN224765) | |
163W00000X Registered Nurse (Licence: CA RN518404) | |
Enumeration Date | 2006-06-14 |
Last Update Date | 2021-09-27 |