| NPI | 1992999759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC APN.19059) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: GA RN218133) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP 9254322) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA APRN218133) | |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2020-02-03 |