| NPI | 1538362306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9437544) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN132559) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2017-06-05 |