| NPI | 1578007480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: IN 71016084A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AZ RN179081) |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ AP9881) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NJ 26NR20877300) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CO C-APN.0001282-C-NP) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60908558) | |
| Enumeration Date | 2016-12-12 |
| Last Update Date | 2025-01-09 |