| NPI | 1700608635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA GAA-NP004619) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 120536) |
| Enumeration Date | 2024-10-30 |
| Last Update Date | 2026-05-22 |