| NPI | 1902839848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10046) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN095208NP) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2018-10-22 |