| NPI | 1750758132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9427082) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN207221) |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2016-05-11 |