| NPI | 1750899738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA NCO000001) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN226903) |
| Enumeration Date | 2018-01-12 |
| Last Update Date | 2018-01-12 |