| NPI | 1841270139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN141132) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL ARNP3343482) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2016-08-17 |