| NPI | 1699178574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 19190) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA APRN-NP301439) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2025-10-10 |