| NPI | 1679432280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ 336173) |
| Additional Taxonomies | 363LA2200X Nurse Practitioner, Adult Health (Licence: AZ 336173) |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: AZ 336173) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: GA GAA-NP004429) | |
| 363L00000X Nurse Practitioner (Licence: GA GAA-NP004429) | |
| 363L00000X Nurse Practitioner (Licence: TX 1196940) | |
| 363LG0600X Nurse Practitioner, Gerontology (Licence: GA GAA-NP004429) | |
| 163W00000X Registered Nurse (Licence: TX 1196940) | |
| Enumeration Date | 2026-01-20 |
| Last Update Date | 2026-08-07 |