| NPI | 1942881255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA F02210757) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN252517) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2022-08-29 |