| NPI | 1972052462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN187790) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL RN9399350) |
| Enumeration Date | 2016-09-26 |
| Last Update Date | 2016-09-26 |