| NPI | 1972546794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP001117) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11027815) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2025-12-29 |