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 | 2025-02-06 |