| NPI | 1972140861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA RN216837) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11003954) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2020-08-11 |