| NPI | 1629790126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KS 53-81619-071) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2019000743) |
| 163W00000X Registered Nurse (Licence: OH 514494) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AK 238465) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ 308093) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2022040629) | |
| 363LF0000X Nurse Practitioner, Family (Licence: CO 102733) | |
| 363LF0000X Nurse Practitioner, Family (Licence: AR 223711) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IL 209.027366) | |
| 363LF0000X Nurse Practitioner, Family (Licence: KY 4038651) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NM 85125) | |
| 363LF0000X Nurse Practitioner, Family (Licence: NY 357433) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OK 212620) | |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-08-01 |