| NPI | 1952708406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN 19467) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: GA RN235060) |
| 363LF0000X Nurse Practitioner, Family (Licence: GA RN235060) | |
| Enumeration Date | 2014-11-28 |
| Last Update Date | 2015-02-23 |