| NPI | 1730626508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: GA RN227622) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: SC 20687) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2018-09-06 |