| NPI | 1417493867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN9257891) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MD AC005872) |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5019547) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0034186) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 24189194) | |
| Enumeration Date | 2017-01-10 |
| Last Update Date | 2024-02-02 |