| NPI | 1649034448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN294015) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN294015) |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-10-16 |