| NPI | 1144705955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NC 196251) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: FL APRN11027829) |
| 363L00000X Nurse Practitioner (Licence: MI 4704409007) | |
| 363L00000X Nurse Practitioner (Licence: SC 26941) | |
| 363L00000X Nurse Practitioner (Licence: GA GAA-NP001897) | |
| 363L00000X Nurse Practitioner (Licence: KY 4007908) | |
| 363L00000X Nurse Practitioner (Licence: VA 0024188992) | |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2024-06-24 |