| NPI | 1164771614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 71008935A) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: IN 28250476A) |
| 163W00000X Registered Nurse (Licence: FL RN9310400) | |
| 163W00000X Registered Nurse (Licence: NV RN80537) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA NP 22695) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: NV APRN001802) | |
| 163W00000X Registered Nurse (Licence: CA RN 805484) | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2023-04-06 |