| NPI | 1588228571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: PA SP020107) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0024191884) |
| 207Q00000X Family Medicine (Licence: WI 16065-33) | |
| 207Q00000X Family Medicine (Licence: SD CP003459) | |
| 207Q00000X Family Medicine (Licence: NJ 26NJ15254600) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP030107) | |
| 207Q00000X Family Medicine (Licence: SC APN.29461RX) | |
| 207Q00000X Family Medicine (Licence: ND 201119) | |
| 207Q00000X Family Medicine (Licence: NC 5021441) | |
| 207Q00000X Family Medicine (Licence: NY 355516) | |
| 207Q00000X Family Medicine (Licence: WV 120837) | |
| 207Q00000X Family Medicine (Licence: GA APRN-NP333625) | |
| 207Q00000X Family Medicine (Licence: CT 12.014212) | |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2025-10-19 |