| NPI | 1427606763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP142365) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0038307) |
| 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0103493-C-NP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 289326) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209031137) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2024029052) | |
| Enumeration Date | 2019-08-29 |
| Last Update Date | 2024-12-30 |