| NPI | 1205575552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AR 220409) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: HI APRN-3712) |
| 363L00000X Nurse Practitioner (Licence: WA AP61327925) | |
| 363L00000X Nurse Practitioner (Licence: NV 853995) | |
| 363L00000X Nurse Practitioner (Licence: OR 202209126NP-PP) | |
| 363L00000X Nurse Practitioner (Licence: DC NP200001621) | |
| 363L00000X Nurse Practitioner (Licence: DE LP-0010579) | |
| 363L00000X Nurse Practitioner (Licence: NM 69950) | |
| 363L00000X Nurse Practitioner (Licence: CO C-APN.0004733-C-NP) | |
| Enumeration Date | 2022-06-02 |
| Last Update Date | 2022-11-29 |