| NPI | 1639518301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN8280937) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN280937) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024170914) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2024-04-15 |