| NPI | 1447762380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: FL APRN9325995) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MO 2024045190) |
| 363L00000X Nurse Practitioner (Licence: AZ 291383) | |
| 363L00000X Nurse Practitioner (Licence: TX 1112411) | |
| 363L00000X Nurse Practitioner (Licence: KY 4035372) | |
| 363L00000X Nurse Practitioner (Licence: IL 209028336) | |
| 363L00000X Nurse Practitioner (Licence: OH 0033013) | |
| 363L00000X Nurse Practitioner (Licence: SC 29997) | |
| 363L00000X Nurse Practitioner (Licence: TN 38021) | |
| 363L00000X Nurse Practitioner (Licence: PA SP032050) | |
| 363L00000X Nurse Practitioner (Licence: AL 3-001918) | |
| 363L00000X Nurse Practitioner (Licence: CO C-APN.0102962-C-NP) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: FL APRN9325995) | |
| 363L00000X Nurse Practitioner (Licence: OR 10040595) | |
| 363L00000X Nurse Practitioner (Licence: MS 907225) | |
| Enumeration Date | 2017-11-01 |
| Last Update Date | 2025-12-15 |