| NPI | 1982218657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA 230470) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA RN301131) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2024-01-02 |