| 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 |