| NPI | 1508515917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN171627) |
| Additional Taxonomies | 101YS0200X Counselor, School |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-08-08 |