| NPI | 1750831954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA APRN-212975) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA 212975) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2022-04-14 |