| NPI | 1871190983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA APRN-NP326207) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IN 28262360A) |
| Enumeration Date | 2020-10-02 |
| Last Update Date | 2025-12-15 |