| NPI | 1588032817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN191921) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: SC 206900) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2023-07-26 |