NPI | 1952799918 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN134641) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 19163A) |
Enumeration Date | 2014-12-29 |
Last Update Date | 2014-12-29 |