| NPI | 1558601211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TN APN0000033497) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: CA 95013249) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61044179) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 254731) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 202008526NP-PP) | |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2024-06-06 |