| NPI | 1659436830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 11134) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN129889 NP) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2018-05-29 |