| NPI | 1003286824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP9278630) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WA 60962308) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL APRN9278630) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CA 95007934) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NV 817161) | |
| Enumeration Date | 2015-10-06 |
| Last Update Date | 2024-05-16 |