| NPI | 1740578863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN201182) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000015644) |
| Enumeration Date | 2011-07-11 |
| Last Update Date | 2023-11-27 |