| NPI | 1033656715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: GA RN275508) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NC 5017243) |
| 363L00000X Nurse Practitioner (Licence: CT 10286) | |
| 363L00000X Nurse Practitioner (Licence: ME CNP211642) | |
| 363L00000X Nurse Practitioner (Licence: NY 431172) | |
| 363LA2100X Nurse Practitioner Acute Care (Licence: CA 95005814) | |
| 363LF0000X Nurse Practitioner Family (Licence: CT 10286) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2023-09-26 |