| NPI | 1598958498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 12835) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA 173410NP) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2007-11-02 |