| NPI | 1588315667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN263513) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN263513) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2023-07-04 |