| NPI | 1497352835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: SC 24770) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX 1154035) |
| 363LF0000X Nurse Practitioner, Family (Licence: TN 36272) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OH APRN.CNP.0030663) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NC 5018996) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AL 3-001745) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11032884) | |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2024-05-20 |