| NPI | 1982086369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: GA RN261508) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: SC 19514) |
| Enumeration Date | 2015-06-23 |
| Last Update Date | 2022-10-26 |