| NPI | 1831354455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN166860) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TN 13528) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2021-05-25 |