| NPI | 1801061452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN233030) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 163538) |
| 163W00000X Registered Nurse (Licence: GA RN233030) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2019-09-03 |