| NPI | 1831624899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN240427) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN240427) |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2017-05-01 |