| NPI | 1457613390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AL 3-000578) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TN 35692) |
| 363L00000X Nurse Practitioner (Licence: FL APRN11015912) | |
| 363L00000X Nurse Practitioner (Licence: TX 1101548) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2024-04-30 |