| NPI | 1730769183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 37884) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP004878) |
| Enumeration Date | 2021-04-10 |
| Last Update Date | 2026-04-08 |