| NPI | 1558855734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care (Licence: NM 57111) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care (Licence: CA 95011671) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: FL ARNP9244033) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: NV 832670) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: CO 1001143) | |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: OK 225814) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2025-11-28 |