| NPI | 1730705989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WI 9884-33) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024191927) |
| 363LF0000X Nurse Practitioner, Family (Licence: WY 55551) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MI 4704420389) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MO 2025008147) | |
| 363LF0000X Nurse Practitioner, Family (Licence: MT 243896) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA 61611209) | |
| 363LF0000X Nurse Practitioner, Family (Licence: IN 71015843A) | |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2025-03-17 |