| NPI | 1669955134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN227482) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 208M00000X Hospitalist (Licence: GA RN227482) | |
| Enumeration Date | 2018-09-11 |
| Last Update Date | 2024-03-07 |