| NPI | 1487816658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 227287) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CO APN.0005718-NP) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 1123553) | |
| 363LF0000X Nurse Practitioner, Family (Licence: UT 13271347-4405) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2023-06-21 |