| NPI | 1780191353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN298483) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: CA 736881) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN2984873) | |
| Enumeration Date | 2018-01-04 |
| Last Update Date | 2021-10-18 |