NPI | 1730797523 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 202213116NP-PP) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: AZ 305586) |
363L00000X Nurse Practitioner (Licence: ID 1461172) | |
363L00000X Nurse Practitioner (Licence: NM 85485) | |
363L00000X Nurse Practitioner (Licence: NV 874007) | |
363L00000X Nurse Practitioner (Licence: UT 13742320-4405) | |
363L00000X Nurse Practitioner (Licence: WA AP61523641) | |
Enumeration Date | 2020-07-17 |
Last Update Date | 2025-08-29 |