| NPI | 1083372098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL 11016929) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 14111) |
| 363L00000X Nurse Practitioner (Licence: TX 1168872) | |
| 363L00000X Nurse Practitioner (Licence: GA NP003015) | |
| 363L00000X Nurse Practitioner (Licence: AL 3-002144) | |
| Enumeration Date | 2021-12-07 |
| Last Update Date | 2025-04-01 |