| NPI | 1932730694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 23652) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP000666) |
| Enumeration Date | 2020-01-31 |
| Last Update Date | 2022-03-30 |