| NPI | 1881169555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 29456) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA NP002788) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9431890) | |
| Enumeration Date | 2018-10-09 |
| Last Update Date | 2024-12-19 |