| NPI | 1265214662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TN 34982) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: UT 14280016-4405) |
| 363L00000X Nurse Practitioner (Licence: NC 5024082) | |
| 363L00000X Nurse Practitioner (Licence: OH 0041420) | |
| 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP004851) | |
| 363L00000X Nurse Practitioner (Licence: FL APRN11045173) | |
| 363L00000X Nurse Practitioner (Licence: AL 3-002945) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 4054927) | |
| 363LF0000X Nurse Practitioner, Family (Licence: SC 31689) | |
| Enumeration Date | 2023-10-19 |
| Last Update Date | 2026-04-06 |