| NPI | 1790200087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN217210) |
| Additional Taxonomies | 163WX0800X Registered Nurse, Orthopedic (Licence: GA RN217210) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2022-07-21 |