| NPI | 1447762380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9325995) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX 1112411) |
| 363L00000X Nurse Practitioner (Licence: OH 0033013) | |
| 363L00000X Nurse Practitioner (Licence: AZ 291383) | |
| 363L00000X Nurse Practitioner (Licence: IL 209028336) | |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2024-05-06 |