| NPI | 1699028696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA APRN-NP244839) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28129625A) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2025-10-29 |