| NPI | 1548812282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA F06190587) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN233162) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN233162) | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-12 |