| NPI | 1871871525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN193399) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN193399) |
| 363LF0000X Nurse Practitioner, Family (Licence: SC APN.17582RX) | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2023-03-17 |