| NPI | 1831268630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN116170) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA RN116170 NP) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2018-06-16 |