NPI | 1447762380 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: FL APRN9325995) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 291383) |
363L00000X Nurse Practitioner (Licence: IL 209028336) | |
363L00000X Nurse Practitioner (Licence: TX 1112411) | |
363L00000X Nurse Practitioner (Licence: OH 0033013) | |
363L00000X Nurse Practitioner (Licence: AL 3-001918) | |
Enumeration Date | 2017-11-01 |
Last Update Date | 2024-09-05 |