| NPI | 1942257175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN206788) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NC 0050-01308) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2011-11-02 |