| NPI | 1841356441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11017375) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN126877) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2022-07-18 |