| NPI | 1497798565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN224765) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA RN518404) |
| 363L00000X Nurse Practitioner (Licence: TN 12467) | |
| 363L00000X Nurse Practitioner (Licence: GA RN224765) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MN 11046) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-08-07 |