| NPI | 1386373082 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11020222) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: GA GAA-NP001381) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0100823-C-NP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 1-115204) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1116322) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 31802) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WV 115830) | |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2025-01-29 |