| 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 |