| NPI | 1215579602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: NV 826867) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95028935) |
| 363LF0000X Nurse Practitioner, Family (Licence: FL 11004595) | |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 13033248-4405) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: UT 13033248-4405) | |
| Enumeration Date | 2019-10-17 |
| Last Update Date | 2024-06-06 |