| NPI | 1699234351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: TN APN23049) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN279101) |
| Enumeration Date | 2019-03-12 |
| Last Update Date | 2022-05-03 |