| NPI | 1619222528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN191172) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: GA RN191172) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2025-07-25 |