| NPI | 1790985463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 201700999NP-PP) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN115938) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2024-03-14 |