| NPI | 1649875311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN187555) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN187555) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA F10200522) | |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2023-05-22 |