| NPI | 1114375664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TN 21491) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 169157) |
| 363LF0000X Nurse Practitioner Family (Licence: VA 0024173702) | |
| 363LF0000X Nurse Practitioner Family (Licence: FL ARNP9470633) | |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2024-08-27 |