| NPI | 1801501630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NC 5022226) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC APN.27251) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN275020) | |
| Enumeration Date | 2023-01-17 |
| Last Update Date | 2025-05-28 |