NPI | 1720430440 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN209851) |
Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: GA RN209851) |
Enumeration Date | 2016-07-06 |
Last Update Date | 2021-01-27 |