| NPI | 1639615636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health (Licence: NY 308155) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95283940) |
| 163W00000X Registered Nurse (Licence: IL 041523720) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: IL 209025964) | |
| 163W00000X Registered Nurse (Licence: TX 1057202) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: CA 95022446) | |
| 163W00000X Registered Nurse (Licence: NY 634664) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: TX 1057202) | |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2026-05-06 |