| NPI | 1861091266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 0000027716) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN242148) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-21 |