| NPI | 1043503113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ND R28464) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: ND R28464) |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1671) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: MT NUR-RN-LIC-77188) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 020144) | |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: ND R28464) | |
| 364SA2200X Clinical Nurse Specialist, Adult Health (Licence: MT NUR-RN-LIC-77188) | |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2017-08-17 |