| NPI | 1942251764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: SC 28922) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: GA GAA-NP001651) |
| 363L00000X Nurse Practitioner (Licence: FL ARNP3308662) | |
| 363L00000X Nurse Practitioner (Licence: NC NC5015048) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2025-10-29 |