| NPI | 1912238460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN218687) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 5004636) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN218687) | |
| Enumeration Date | 2010-01-22 |
| Last Update Date | 2021-03-16 |