| NPI | 1639943764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: GA GAA-NP001855) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: AL 1-123660) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AL 1-123660) | |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2023-11-22 |