NPI | 1902033780 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN107315) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN107315) |
363LX0106X Nurse Practitioner, Occupational Health (Licence: GA RN107315) | |
Enumeration Date | 2009-06-18 |
Last Update Date | 2021-05-15 |