| NPI | 1043281918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 10486714-4405) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AK NURR35587) |
| 164W00000X Licensed Practical Nurse (Licence: CO 35732) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 120392) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2018-03-17 |