| NPI | 1922770916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 214166) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN278883) |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2025-01-20 |