| NPI | 1972018364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN234959) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008309) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2024-05-09 |