| NPI | 1548643307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN204167) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: MD R215808) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2016-07-11 |