| NPI | 1598116485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 20278) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9485027) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN276959) | |
| Enumeration Date | 2016-06-22 |
| Last Update Date | 2025-07-03 |