| NPI | 1629305172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008208) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: DC RN1005781) |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024168515) | |
| 363LF0000X Nurse Practitioner, Family (Licence: FL ARNP-9360991) | |
| 363LF0000X Nurse Practitioner, Family (Licence: PA SP012948) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM CNP-02221) | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2022-04-11 |