| NPI | 1639833247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 25633) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN184281) |
| Enumeration Date | 2021-10-29 |
| Last Update Date | 2025-12-15 |