| NPI | 1104371806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95004610) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95004610) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 813583) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NM 54130) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: WA AP61019951) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OR 202005274NP-PP) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: AZ 219427) | |
| Enumeration Date | 2016-08-23 |
| Last Update Date | 2020-07-21 |