| NPI | 1831242049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 12168) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN161233) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2025-02-11 |