| NPI | 1255970869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NY 0347021) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA Rn282379) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024178830) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KS TMP-159931) | |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2021-03-17 |