| NPI | 1154626521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006776) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.019811) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5008544) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71006200A) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 9421762) | |
| Enumeration Date | 2011-01-17 |
| Last Update Date | 2023-07-13 |