| NPI | 1043518087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 4470) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1175483) |
| 363LF0000X Nurse Practitioner, Family (Licence: OH 0035758) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5012797) | |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2024-11-20 |